Effective October 2015, the International Classification of Diseases was updated. With the improved information, more moderate traumatic brain injuries can be counted. Previously, some cases were categorized as unclassifiable severity due to more limited surveillance information. Also in 2015, the Assistant Secretary of Defense clarified the TBI case definition. A subsequent review found that some of the remaining unclassifiable cases were likely moderate TBI. This change also will contribute to higher counts of moderate TBI surveillance cases. Worldwide numbers represent medical diagnoses of TBI that occurred anywhere U.S. forces are located including the continental United States since 2000. Concussion/Mild TBI is characterized by the following: Confused or disoriented state which lasts less than 24 hours; or loss of consciousness for up to 30 minutes; or memory loss lasting less than 24 hours. Excludes penetrating TBI. A CT scan is not indicated for most patients with a Mild TBI. If obtained, it is normal. Moderate TBI is characterized by the following: Confused or disoriented state which lasts more than 24 hours; or loss of consciousness for more than 30 minutes, but less than 24 hours; or memory loss lasting greater than 24 hours but less than seven days; or meets criteria for Mild TBI except an abnormal CT scan is present. Excludes penetrating TBI. A structural brain imaging study may be normal or abnormal. Severe TBI is characterized by the following: Confused or disoriented state which lasts more than 24 hours; or loss of consciousness for more than 24 hours; or memory loss for more than seven days. Excludes penetrating TBI. A structural brain imaging study may be normal but usually is abnormal. Penetrating TBI, or open head injury, is characterized by the following: A head injury in which the scalp, skull and dura mater (the outer layer of the meninges) are penetrated. Penetrating injuries can be caused by high-velocity projectiles or objects of lower velocity such as knives, or bone fragments from a skull fracture that are driven into the brain.
Army Guard Penetrating 2,553 Severe 1,871 Moderate 16,147 Mild 140,746 Not Classifiable 11,834 Penetrating 491 Severe 365 Moderate 3,160 Mild 29,204 Not Classifiable 2,269 Penetrating 167 Severe 181 Moderate 1,512 Mild 13,501 Not Classifiable 1,143
Navy Penetrating 592 Severe 473 Moderate 5,337 Mild 39,546 Not Classifiable 2,272 Penetrating 45 Severe 30 Moderate 396 Mild 3,288 Not Classifiable 169
DoD Numbers for Traumatic Brain Injury Worldwide Air Force 5.6% 2000-2018 Q1 44,308 Guard 5,023 2,951 Total - Air Force 52,282 9.6% 84.7% Source: Defense Medical Surveillance System (DMSS), Theater Medical Data Store (TMDS) provided by the Armed Forces Health Surveillance Branch (AFHSB) Service Component Severity Diagnosed Air Force Guard Penetrating 497 Severe 418 Moderate 4,196 Mild 37,867 Not Classifiable 1,330 Penetrating 53 Severe 37 Moderate 492 Mild 4,290 Not Classifiable 151 Penetrating 31 Severe 26 Moderate 290 Mild 2,510 Not Classifiable 94
Marines Penetrating 721 Severe 613 Moderate 5,452 Mild 41,355 Not Classifiable 1,885 Penetrating 65 Severe 53 Moderate 442 Mild 3,590 Not Classifiable 197